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Roster Verification Enters Second Stage

The process for establishing the case mix index (CMI) for July 2020 nursing home Medicaid rates has entered the second stage. In the first stage, homes had until Nov. 27th to file any necessary Minimum Data Set (MDS) corrections with the Centers for Medicare and Medicaid Services (CMS) after reviewing the list of residents the Department of Health (DOH) had posted on the Health Commerce System (HCS). In the second stage, providers are required to verify that the appropriate MDS is listed for each resident who was in the facility at 11:59 p.m. on Jan. 29, 2020. For existing residents, this should be the MDS with the most proximate assessment reference date (ARD) through Jan. 29th. For newly admitted residents, this should be the most current assessment through Feb. 11, 2020.

Please note that providers must verify and “set the match” for all residents in the facility on Jan. 29th, but that only Medicaid residents (Medicaid, Medicaid Pending, Medicaid Managed Care, Managed Long Term Care (MLTC), Program of All-Inclusive Care for the Elderly (PACE), Medicaid Advantage Plus (MAP), and Fully Integrated Duals Advantage (FIDA)) will be included in the CMI calculation. This step must be completed by Dec. 31st, and the operator’s certification must be submitted by Jan. 8th.

If providers encounter a situation where a resident that was in house on the picture date does not appear on the HCS list or if the incorrect assessment is matched to a resident, they should contact DOH by sending an email to BLTCRMDS using the secure transfer application on the HCS. Questions that do not include resident-identifying information can be submitted to MDSBRHCR@health.ny.gov. (Please note the different email addresses). Instructions for using the secure transfer function of the HCS are available here (see page 22).

The Dear Administrator Letter (DAL) lays out the timeline for this round of roster verification, which uses a streamlined process first used earlier this year. The slides from the June DOH webinar describing the process are available here, and the full archived webinar is here. (Please note that while the information in the presentation is correct, the dates shown on the slides are not updated and still indicate the schedule from the prior collection period.) Please note that an enhancement has been added for this round that will allow a provider that has finalized the match to update roster information without having to contact DOH staff to request that it be “unlocked.” The roster verification process does not apply to specialty facilities and units, since case mix updates are not being made to specialty rates.

The new roster verification process has no impact on how the CMI is calculated or on the MDS assessments that are used for the calculation. It simply provides a more efficient way for DOH to compile, and for providers to verify, the data that is customarily used for calculating CMI.

We urge members to review their facility data carefully for accuracy well before the Dec. 31st deadline, to contact DOH if corrections are needed, and to let us know if they encounter any difficulties with the process.

Contact: Darius Kirstein, dkirstein@leadingageny.org, 518-867-8841